Here’s a short article I wrote for the local paper…
Trauma and Children – Do we always recognize the effect on children and adolescents?
Much of what we know about trauma and how it affects our children is based on the work of mental health professionals that have focused on adults, including the large amounts of research done on PTSD (post-traumatic stress disorder). My early work with children that had experienced domestic violence in the home was during a time when very little was known about the effects or the proper treatment to help these children or their mothers. However, new developmental research, mostly in the past two decades, have concentrated on children and adolescents that experience domestic violence in the home, school violence, physical and sexual abuse, emergency medical care, and car accidents. The fear, the anxiety, and the sense of helplessness that accompanies such events often results in dramatic reactions and behavioral changes in the child.
The American Psychological Association (APA) defines ‘trauma’ as a threat of injury, death, or an event that is experienced by the child as threatening the physical integrity of self or other person – causing fear, terror, or helplessness. The behavioral changes may include separation anxiety in the child, sadness or anger that was not observed prior to the event, sleep disturbances, or difficulties in the ability to focus or concentrate – often causing problems in the home or in school. Oftentimes, because the family may be suffering, or because of cultural or ethic factors, parents may not be able to make sense of the behaviors or notice if the changes are slight and gradual. The children may not show immediate effects to the event, for example to a dog bite or a car crash. In the case of sexual abuse, the parents may not know right away of its occurrence – and so the signs or symptoms exhibited will not be understood by the parents.
Further, the responses of children and adolescents will vary, depending on the child’s age, their developmental level, and of course, previous exposure to the threat or traumatic experience. That is, if the threat or event is chronic – as in domestic violence in the home – or is acute, happening now – for example, a bad car crash. Some estimates (from psychological studies) suggest that 2/3 of children up to age 16 have experienced or been exposed to trauma, or the threat of trauma. Up to nearly 5 million children have been exposed to or experienced trauma – many from abuse, both sexual and physical – and violence in the home.
As the diagnostic criteria have recently been more adequately studied, we can understand the apparent increase in disorders of anxiety in children, including the increase in diagnoses of post-traumatic stress disorder. (PTSD is a sub-category of anxiety diagnosis). Intrusive thoughts or memories related to the trauma will interfere with the child’s thinking, as well as their ability to focus. As the experience is far outside the realm of normal experience, the child’s normal mechanisms for adapting to the environment or situation may fail him or her, leaving them feeling more vulnerable. The child or the adolescent cannot make sense of the experience as it does not conform to their usual experience, and thus cannot adapt and master the thoughts and emotions that are occurring to them.
Different professionals will have different perspectives on what constitutes trauma, and how best to approach it therapeutically. There are not sufficient studies to support the effectiveness of any one therapeutic approach yet, though cognitive behavioral therapy is perhaps seen by many as the most effective. The need for what is referred to as ‘evidence based treatment’ continues – treatment that has been shown to be effective for children, adolescents, and adults – based on reliable and valid research.
What has been shown to be effective is that the quality of the therapeutic relationship is the key to success. The safe, secure, and trusting relationship between the therapist and child, the parents, and the school personnel – all of whom can support the strengths and resources of the child or adolescent needs to be fostered. Coping skills must be identified and strengthened – and these can be supported through psychotherapy or counseling, individual help through tutoring (giving child individual attention), stress reduction exercises, such as mindfulness activities or meditation, and fostering leisure activities.
It is also important to establish and maintain the structure and routines of everyday life, with meals and school or extracurricular activities as good ways to provide the necessary structure. Finally, it is important to engage the community, letting school or church personnel know of the event or experience, as well as others that have contact with the child, so that their child’s behavior is understood in the proper context by the teachers or counselors. These suggestions will help foster a support network for the child or adolescent – with trusted and safe adults.
More information on trauma is available through the American Psychiatric Association and the American Psychological Association. Please also feel free to email me with questions or comments on the subject.
Rudy Oldeschulte, M.A., J.D. is a Del Rio psychotherapist, specializing in individual psychotherapy and parent guidance. He has served on the faculty of the University of Arizona College of Medicine and the British Association of Psychotherapists. Post- graduate training and education was done in London and at the University of Michigan.